Good Faith Estimate (No Surprises Act)

 

Below, you will find information about self-pay rates and insurance, as well as potential additional charges that cannot be billed to insurance.  Please note that time reflected in coding may also include reviewing records and test results, collaborating with other clinicians, documentation, and other such tasks.  Payment is due on the date of service.  If you have any questions about your bill, please contact Dr. Biggs at bbiggs@stillwaterconsulting.org or 978-577-4833. This information was last updated on 2/12/2023

  • Primary Services Provided and Associated Fees:

    99205: Initial Evaluation (60 minutes)

    90792: Psychiatric Diagnostic Evaluation with Medication Services (30-60 minutes)

    99214: Evaluation and management of established patient with moderate medical decision making - **Typical follow up with 90833/90836**

    90833: Psychotherapy (16-37 minutes) add on for medication management

    90836: Psychotherapy (38-52 minutes) add on for medication management

  • Self-Pay

    Currently, the fee for self-pay medication management and psychotherapy for Bonnie Biggs DNP, APRN, PMHNP-BC is $300/hour (pro-rated), and is based on the time booked.

    $150 for up to 30 minutes

    $225 for 31-45 minutes

    $300 for 46-60 minutes

  • Insurance

    The codes above, and sometimes others, will be billed to your insurance company at the discretion of your provider. Your responsibility is determined by your specific insurance plan. As we do not have access to full details about your policy, we will abide by all documentation submitted to us by your insurance company. You will be charged the amount that your insurance company indicates to us, which may include copays, coinsurance payments, secondary payments, deductible payments, etc. If your insurance takes back payments made for any reason and you are unable to resolve the matter, you will be charged the self-pay rate as noted above for services rendered. If your insurance coverage changes in any way, it is your responsibility to notify your provider and fill out the insurance verification form at https://kasmedicalbilling.medforward.com/Forms.aspx. If you lose coverage or change to an out of network policy, your account will be converted to self-pay and you will be charged as such.

  • Additional Services and Fees

    This information serves as notice of additional fees you may incur based on your personal circumstances. These fees are not included in the Good Faith Estimate, due to the unpredictable nature of each patient’s needs, and cannot be billed to insurance. Please note that fees for late cancellation/no show is documented in the consent form. Any other fees listed below will be discussed before work is completed and fees are assessed.

    Requested documentation, written letters, forms completed outside of scheduled appointments >10 min time for completion: $200/hour prorated

    No Call/No Show: $100

    Extensive collaboration with other providers.

  • Disclaimer

    This Good Faith Estimate shows the cost of items and services that are reasonably expected for your healthcare needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur. If this happens, federal law allows you to dispute (appeal) the bill.

    The Good Faith Estimate is not a contract and therefore does not require you to obtain the items or services provided by Stillwater Consulting, LLC, and you have the right to terminate care at any time.

    If you are billed for more than the Good Faith Estimate, you have the right to dispute the bill.

    You may contact the health care provider or facility listed to let them know the billed charges are higher than the Good Faith Estimate. You can ask them to update the bill to match the Good Faith Estimate, ask to negotiate the bill, or ask if there is financial assistance available.

    You may also start a dispute resolution process with the U.S. Department of Health and Human Services (HHS). If you choose to use the dispute resolution process, you must start the dispute process within 120 calendar days (about 4 months) of the date on the original bill.

    There is a $25 fee to use the dispute process. If the agency reviewing your dispute agrees with you, you will have to pay the price on this Good Faith Estimate. If the agency disagrees with you, and agrees with the health care provider or facility, you will have to pay the higher amount.

    To learn more and get a form to start the process, go to www.cms.gov/nosurprises or call 1-800-985-3059.

    For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-800-985-3059